The Health Systems in Transition (HiT) profiles are country-based reports that provide a detailed description of a health system and of policy initiatives in progress or under development. HiTs examine different approaches to the organization, financing and delivery of health services and the role of the main actors in health systems; describe the institutional framework, process, content and implementation of health and health care policies; and highlight challenges and areas that require more in-depth analysis.
Australia is a prosperous country with GDP per capita near the OECD average and with a culturally diverse population of 20 million. The population generally enjoys good health and increasing life expectancy, currently at 80 years. Most Australians have access to comprehensive health care of a high standard, financed mainly through general taxation. Fiscal and functional responsibilities for health care are divided between the Australian Government and six States and two Territories, and between public and private providers, so that the ability of any one actor to plan or regulate is limited. Equity is maintained in that health care is funded primarily by progressive taxation, but several disparities have arisen, including increased out-of-pocket payments, differential access to dental care, and concerns that increased private health insurance will encourage a two-tier health system. Efficiency can be improved given duplicated governance and despite gains in microeconomic reforms. Quality is receiving more attention, despite limited monitoring of clinical outcomes. Some endemic problems have eluded solutions: whether rising health expenditure is sustainable, tensions between levels of government, long waiting lists for elective surgery, disparities in urban and rural service access, and the continuing poor health status of Indigenous Australians. Major reforms will depend upon the ideological preferences of governments and their political will to achieve change in a complex health system.